AVATAR系统是第一个发表的放射治疗(RT)兼容系统，通过基于视频的注意力分散减少了小儿麻醉需求。我们在一项多中心小儿试验中评估了AVATAR实施的可行性以及其对麻醉使用率、生活质量(QoL)和焦虑症状的影响。招募了10所机构的3-10岁准备接受RT的小儿进行前瞻性登记。只要能够使用AVATAR进行至少一次RT部位照射而不需要麻醉的患儿被视为成功(S)。对于整个治疗过程需要麻醉的患者被视为非成功(NS)。采用小儿癌症模块调查(PedsQL)，在RT模拟、RT进行中和最后一次治疗时向患儿和监护人提问，以评估其QoL。采用修改版的耶鲁术前评估调查短表(mYPAS)评估焦虑症状，同样在三个时间点进行评估。使用卡方检验评估成功率。使用混合效应模型评估PedsQL和mYPAS得分，将时间点作为固定效应，主体上的随机拦截器。共包括81名儿童，中位年龄为7岁。AVATAR在所有10个机构和质子和光子RT中均获得成功。共有63例(78%)的成功患者，在每个患者身上避免了20个中位数照射。成功率因年龄(p=0.04)和私人保险和公共保险(p<0.001)而有所不同。在5-7岁患者中，患者(p=0.008)和家长(p=0.006)的PedsQL分数在治疗过程中显著改善。治疗室内无论是成功(S)患者还是非成功(NS)患者，在治疗过程中焦虑症状都有所减轻(p<0.001)，这与年龄(p<0.001)和S患者与NS患者(p<0.001)也有关。在这项涉及10个中心的前瞻性试验中，AVATAR避免麻醉的成功率为78%，高于年龄相当的历史对照组(49%，p<0.001)。AVATAR的实施在多个机构中是可行的，应进一步研究并提供给可能受益于基于视频的注意力分散的患者。版权所有© 2023 Elsevier Inc. 发布。

The AVATAR system was the first published radiotherapy (RT) compatible system to reduce the need for pediatric anesthesia through video-based distraction. We evaluate the feasibility of AVATAR implementation and effects on anesthesia use, quality of life (QoL), and anxiety in a multicenter pediatric trial.Pediatric patients 3-10 years of age preparing to undergo RT at 10 institutions were prospectively enrolled. Children able to undergo at least one fraction of RT using AVATAR without anesthesia were considered successful (S). Patients requiring anesthesia for their entire treatment course were non-successful (NS). PedsQL3.0 Cancer Module survey (PedsQL) assessed QoL and was administered to the patient and guardian at RT simulation, midway through RT, and final treatment. The modified Yale Preoperative Assessment Survey Short Form (mYPAS) assessed anxiety and was performed at the same three timepoints. Success was evaluated using Chi-square test. PedsQL and mYPAS scores were assessed using mixed effects models with time points evaluated as fixed effects and a random intercept on the subject.Eighty-one children were included; median age was 7 years. AVATAR was successful at all 10 institutions and with photon and proton RT. There were 63 (78%) S patients; anesthesia was avoided for a median of 20 fractions per patient. Success differed by age (p=0.04) and private versus public insurance (p<0.001). Both patient (p=0.008) and parent (p=0.006) PedsQL scores significantly improved over the course of RT for patients ages 5-7. Anxiety in the treatment room decreased for both S and NS patients over RT course (p<0.001), by age (p<0.001) and by S versus NS patients (p<0.001).In this 10-center prospective trial, anesthesia avoidance with AVATAR was 78% in children age 3-10 years, higher than among age-matched historical controls (49%, p<0.001). AVATAR implementation is feasible across multiple institutions and should be further studied and made available to patients who may benefit from video-based distraction.Copyright © 2023. Published by Elsevier Inc.